I didn't see the show, but I actually had a case (in real life) that was eerily similar. Well, it wasn't MY case, and all the other docs and CNMs advised me to avoid the chart like the plague... but I was on for L&D that night, and was working in the room next door to the commotion...

The surrogate in this case had delivered 5 of her own vaginally without any difficulty. The biological mother was ranting and raving around, acting like she owned the place, creating a very hostile atmosphere, and making us all very unconfortable, much less the surrogate. (We developed a very low opinion of her over time as we learned more about her.) Anyway... the baby began having some variable decels, and even though was a vertex presentation, started to really worry the attendings. We tried to consent her for c/s and she flat refused. Her labor wasn't progressing either.

After several tense hours, (and the bio mom on the phone with the lawyer already - screaming about her baby's impending brain damage), the surrogate miraculously progressed and delivered. Pretty quickly, I might add. (Can you say "pitocin?" )

So yeah, I was up close and personal with a strangely similar case. But it was in L&D - not the ED! And I've very glad that the baby wasn't harmed (as far as we know) - because that surrogate flat out refused the c/s. I'm also very glad that I wasn't the OB sweating it out.


Nope, not realistic at all. But I realized that once I saw an intern on the show do a ventriculostomy in the ER... um, yeah.

Dr Heather, footling breech is not an undeliverable position. It's certainly more dangerous to deliver, due to the increased risk of cord prolapse and entrapment of the head by the not-completely-dilated cervix, and I don't know anyone who would willingly take on a footling breech vaginal delivery, but babies have indeed been born that way. A urologist in town here used to tell the med students the story of his first delivery (whenever he heard them in the doctor's lounge nervously anticipating their firsts). He was rotating through the Chicago Maternity Service as a med student, in the days when they maintained a home birth service where anyone could call in labor and they would send out first a med student and student nurse to assess the situation. This guy arrived in a tenement apartment with his student nurse partner, to find a teenage girl in active labor (and completely out of control) with her first, and immediately encountered 2 feet in the vagina. He called his resident backup, who was tied up elsewhere and couldn't make it, so he instructed him over the phone and they managed to get the baby out OK. He sat down to mop his brow and try to get his hands to stop shaking, and immediately a SECOND pair of feet appeared in the vagina. Mom and babies were ultimately fine, but I think the episode may have helped this guy decide that OB was not for him. The story always made med students feel much better about only having a singleton vertex with attending hands hovering nearby for their first.

I wouldn't want to try and defend delivering a footling in court! Your :censored: is grass and the lawyer is a lawnmower!!

I wouldn't either. Didn't say it's a good idea, just that it has been done. "Back in the day" (as my kids would say), before c-section was a safe option, babies that were't making much headway coming vertex were sometimes intentionally converted to footling breeches (internal podalic version) and yanked out by the feet. (wouldn't do that either--just an interesting historical sidelight).

AmmaM - I didn't mean to say "undeliverable" in the strictly technical impossible sense (All vaginal breeches end up footling eventually, do they not ?). I should have said that no OB, in this day and age, would agree to let a footling breech labor.

I've got a good footling breech story, too (undiagnosed twins, presenting twin sticks out a foot in the middle of labor - the old OB didn't ever do ultrasounds on his patients - even in this mom who was HUGE HUGE HUGE - she got sectioned, and no one figures out the twin thing until AFTER the firs baby was out! The resident had done the L&D ultrasound...yep...that's head...yep...that's butt (missing an entire BABY in the process!)

Had to correct myself b/c I can't stand the though of any of you guys thinkinf I don't know what I'm talking about